Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 002827 | GA |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 002827 | GA |
NPI | 1235548603 |
---|---|
Provider Name | Dr. Lauren Dyak |
First Address | Atlanta, GA 30350-6887 |
Second Address | Atlanta, GA 30350-6887 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2014 |
Last Update Date | 09/09/2015 |